Physicians' compliance with the National Drug Policy on Malaria in a tertiary teaching hospital, India, from 2010 to 2015: a mixed method study.

Background: National drug policies are formulated to encourage rational use of drugs and to reduce drug resistance. This study assessed physicians' compliance with the National Drug Policy on Malaria at a tertiary care hospital in north India.

Methods: This mixed method study extracted data from adult malaria inpatient records of the hospital from 2010-2015, and assessed drug supply at pharmacies. Physicians' practices and perspectives were explored by in-depth interviews. Compliance was assessed by severity, type of species and pregnancy status. Thematic analysis was done for the qualitative data.

Results: A total of 247 case files were reviewed. Vivax malaria (41.0%) was more common than falciparum malaria (37.2%). The majority (90.8%) of cases were severe malaria. Overall compliance for use of schizonticidal drug was 73.0% in severe malaria and was only 9.5% in uncomplicated malaria. Compliance for use of gametocidal drug (primaquine) was 15.3%. Schizonticidal drugs were available in all pharmacies except the public one. Primaquine was available in only one. The main themes emerging in the thematic network analysis were physicians' misconceptions, physician-related factors, and hospital-related and drug access factors.

Conclusions: The degree of compliance for severe malaria treatment was reasonably good but low for radical cure. Raising knowledge and awareness among health care providers, by using written treatment protocols and continuing medical education would improve compliance.